Focusing on Combination Prevention and Treatment, Child Protection and Wellbeing, Food Security and Income Generation, AFSA aims to deliver quality services to communities most in need. Policy and Practice through the promotion of equality, education and access to basic services is a cornerstone of these efforts.
AFSA recognises that the HIV epidemic is rooted in social and relational phenomena conditioned by environmental, cultural, political and socio-economic drivers. Given the complex reality that HIV affects communities and subgroups differently, AFSA uses strategies that address the social and structural drivers of HIV/AIDS and integrates interventions into a broader sexual and reproductive health framework. AFSA focuses on geographies and populations with elevated risk, thereby effectively and efficiently maximizing prevention impact.
AFSA’s work is oriented around UNAID’s 90-90-90 global target, which calls for countries to achieve the following by 2020:
- 90% of all people living with HIV know their status
- 90% of all people diagnosed with HIV receive sustained antiretroviral therapy
- 90% of people receiving antiretroviral therapy have viral suppression
In order to address the current prevention gap in Eastern and Southern Africa, AFSA’s strategic plan takes the 90-90-90 target into account as it works towards closing the gap in testing, treatment and care.
AFSA’s Strategic Action Plan 2016-2020 includes the following objectives:
- Reduce new HIV, TB & STI infections through the delivery of customised interventions targeting priority populations
- Address priority social and structural determinants of HIV and TB
- Strengthen community systems for improved health and development outcomes in marginalised communities
- Ensure universal access of services to all through the protection of human rights and access to justice within communities and healthcare settings
- Drive AFSA’s organisational effectiveness
To achieve this, AFSA works towards strengthening:
- Demand-side interventions that improve risk perception and awareness and acceptability of prevention approaches (more individuals test and know their status, specifically hard-to-reach and underserved individuals and populations)
- Supply-side interventions that make prevention products and procedures more accessible and available
- Adherence interventions that support ongoing adoption of prevention behaviours, including those that do and do not involve prevention products
In order to support the South African response to the 90-90-90 strategy, AFSA assists in identifying people living with HIV outside of healthcare facilities, supports their adherence to treatment and linkage into care, and focuses on improving data quality and flow amongst implementing partners and key stakeholders. AFSA strategically positions itself to work in partnership with CBOs and NGOs because of their access and close proximity to vulnerable communities and target populations. AFSA believes that community participation and ownership is key to ensuring success and sustainability of local interventions, and that communities be agents of their own development. Through this, AFSA is able to successfully extend reach of quality interventions, to remote, rural and hard-to-reach communities.
AFSA’s History and Milestones
The AIDS Foundation of South Africa (AFSA) was established by group of activists in Cape Town, many of whom had lost partners, family members and loved ones to AIDS. AFSA was set-up to create a legal entity that could raise and distribute funding to finance HIV/AIDS education and care projects. At this early stage AFSA had no paid employees, instead everyone that supported the Foundation worked in a voluntary capacity. It was only in 1992, when AFSA received a bequest was it possible to appoint a full time Executive Director and a Fundraiser. AFSA’s first Executive Director was Dr Stuart Harris.
The AFSA Board took a decision to set up offices in KwaZulu Natal and Gauteng. Ms Debbie Mathew was appointed as Fundraiser and Projects Coordinator in KwaZulu Natal, while Professor Ruben Sher, a leading clinician in HIV/AIDS in South Africa, headed up AFSA’s operations in Gauteng. During these early days, which coincided with the dawn of democracy in South Africa, sourcing funding for HIV/AIDS projects was challenging as there were so many other competing developmental priorities; and there was this misguided perception that HIV/AIDS was not a serious problem because for many people it remained largely “unseen” or “invisible”. In these early years, funds raised were distributed primarily to palliative care and hospice projects, support groups for people living with HIV, HIV/AIDS education and prevention projects, and psychosocial and home based care services. Some of the early beneficiary projects supported by AFSA included, amongst others, St. Luke’s Hospice, the AIDS Support and Educational Trust (ASET which later became Triangle Project); NAPWA; community outreach projects at Hlabisa, Mosveld and Manguzi hospitals in rural northern KwaZulu Natal (uMkhanyakude); Friends for Life and the Salvation Army’s Ethembeni Children’s Home in Gauteng.
This period was the start of AFSA’s working relationship with a number of Traditional Healer Associations and the beginning of what was to become AFSA’s flagship program over the next decade. AFSA recognised that traditional health practitioners were strategically well positioned to play a key role in HIV education, prevention and support within large sectors of society that consulted and depended upon traditional health practitioners for their physical, emotional and overall wellbeing. Through this program AFSA worked with Traditional Healer Associations in KwaZulu Natal, the Eastern Cape, the Free State, Gauteng and Mpumalanga – with more than 6000 traditional health practitioners participating in the five day HIV/AIDS education and prevention course; and in later years a three day treatment literacy and care course was introduced for traditional health practitioners. During this period AFSA worked with some of the most prominent Traditional Health Practitioners that were at the forefront of the struggle against HIV/AIDS. These included: Traditional Doctors: Patience Koloko, Merci Manci, Nkosnathi Dlamini, Queen Ntuli, Molefi Rakauoane and Petros Mpila amongst others. This work was funded by the Interchurch Organisation for Development Cooperation (ICCO), Brot fur die Welt, the Department of Health, the National Development Agency and a number of local corporate social investment donors.
In late 1996 Mr Gary Adler was appointed as AFSA’s Executive Director and the decision was taken to move the AFSA head office from Cape Town and consolidate operations in Durban as KwaZulu Natal was the province where most of AFSA’s supported programs and organisations were operating.
During the late nineties, AFSA also began to provide extensive support to programs working with Orphaned and Vulnerable Children (OVC) and their caregivers, many of whom were either grandmothers or older siblings. This work continued for many years as HIV/AIDS related morbidity and mortality remained at alarmingly high levels for the next decade. Donors such as the Bernard van Leer Foundation, the Elton John Foundation, Misereor and Kerkinactie. In later years ELMA Philanthropies and Wereldkinderen also provided support for child protection programs. These programs focussed on identifying OVC households, providing support to distressed OVC households, assisting caregivers to access social security grants for OVC, strengthening coping mechanisms and household resilience, providing psychological support, bereavement counselling and play therapy for OVC; and strengthening child protection systems in local communities.
In 2000 AFSA secured a sizable grant from the European Commission which enabled AFSA to broaden its support to community based organisations in KwaZulu Natal, the Free State and Mpumalanga. These organisations provided a package of services that included HIV prevention, support groups, drop-in centres and income generating projects for people living with HIV including home and community based care and nursing services, community based early childhood development groups and after school homework clubs for OVC.
The year 2000 was also a watershed year in the struggle against HIV/AIDS. The XIII International AIDS Conference was held in Durban, South Africa. This was the first time this conference had been held in a developing country and more than 4000 delegates from African countries participated in the Conference, the theme of which was “Breaking the Silence”. The conference was held at a time of AIDS denialism arising primarily from the views of the then President of South Africa Mr Thabo Mbeki. This resulted in the issuing of the ‘Durban Declaration’ a statement signed by over 5,000 physicians and scientists in the year 2000, affirming that HIV is the cause of AIDS. The conference also saw the Treatment Action Campaign, which had been established in December 1998, organise and lead a major march at the start of the Conference demanding access to antiretroviral treatment for PLHIV in developing countries, treatment for the prevention mother to child transmission of HIV, and treatment to manage and treat opportunistic infections. The march also called for an end to exorbitant pricing and exploitation by pharmaceutical companies which denied people access to affordable treatment, an end to the South African government’s AIDS denialism and demanded that the government start parallel importation, compulsory licensing and provide affordable drugs including ARVs and treatment for PMTCT. AFSA and many of its sub-recipient organisations participated in the march, while AFSA had also participated in the planning committee for the march and had contributed toward the cost of hosting the march. For the next decade the Treatment Action Campaign was at the forefront of the struggle for access to treatment and used multiple strategies which included: using the law; taking TAC to the people; “We can learn the science of HIV works”; learning from doctors and other activists; antiretroviral can work in Africa; myths of poison drugs and biological warfare; and wearing my HIV positive t-shirt. The end to state sponsored AIDS denialism and the introduction, and eventual large scale roll-out; of ARV treatment in the public health sector was largely the result of the tireless activism lead the TAC and the AIDS Law Project (known today as SECTION27). Over the years AFSA provided financial support to the work of these two organisations.
In July 2004 AFSA received the first of a number of funding grants from the Swedish International Development Cooperation Agency (Sida). AFSA’s relationship with Sida has continued to date. Sida initially provided funding for support to emerging community based organisations in KwaZulu Natal, the Eastern Cape and Northern Cape while also making funding available to support national advocacy organisations to effect structural policy and social change. In more recent years, since 2014 AFSA has received support through the Sida regional office in Lusaka to implement the Sexual Reproductive Health Rights Program that works to promote and catalyse the realisation the SRHR of marginalised and most at risk populations in southern and east Africa; and facilitate the sharing of experience, lessons, and knowledge between SRHR advocacy organisations in the region.
In 2006, AFSA received a sizable funding grant from the Atlantic Philanthropies to strengthen the capacity of community level programming. This resulted in AFSA formalising the training workshops and onsite support provided to sub-recipient partner organisations, with the establishment of a dedicated Capacity Building Department and AFSA’s registration as an accredited training service provider with the Health and Welfare SETA. The Atlantic Philanthropies grant also enabled AFSA to strengthen Community Care Centres (CCCs) in KZN, Limpopo and the Northern Cape provinces and to improve the skills of Community Health Workers and Child and Youth Care Workers through accredited training and ongoing mentorship and coaching. The CCCs were established as a joint venture between the departments of Social Development, Health and Education to provide a support structure for OVC in communities with high numbers of OVC and distressed households. The CCCs provided ECD services to preschool children, operated homework clubs for OVC attending school, life skills and holiday programs for OVC, psychosocial support, and soup kitchens for OVC.
In 2010 AFSA introduced a Culture and Health Program funded by the Royal Netherlands Embassy. The purpose of the Culture and Health Program was to support community projects that sought to explore and reflect on how cultural practices affected health both positively and negatively. The projects supported though the Culture and Health Program also served as catalysts within communities helping others to begin to recognise and discuss ways in which specific cultural practices affected health behaviours as well as mental and physical wellbeing. The specific populations targeted through the program included: rural men and adolescent boys, traditional health practitioners, traditional leadership structures, the Khoi San communities in the Northern Cape, and LGBTI communities.
In 2010 AFSA secured a funding grant from the Centers for Disease Control and Prevention to implement an HIV Combination Prevention Program in KZN. This was the start of AFSA’s direct involvement in the delivery of community based HIV testing services and the linkage of clients to treatment and care; conducting demand creation for voluntary medical male circumcision; and facilitating the Families Matter Program, a skilful parenting program targeting the parents/caregiver of preadolescent children. AFSA was subsequently appointed as an implementing partner for the DREAMS program targeting adolescent girls and young women. In recent years AFSA has received support from the CDC via MatCH (Maternal Adolescent and Child Health a subsidiary of the Wits Health Consortium) and the Health Systems Trust.
In 2012 AFSA was appointed as a Provincial Implementing Agent for the Community Work Program (CWP) in the UGu and Harry Gwala districts in KwaZulu Natal. AFSA was responsible for deploying and supervising 7500 participants that were engaged in work that benefitted their local communities, while providing participants with a predictable level of work and income each month. Much of the work performed through the CWP supported and strengthened the community programs being implemented by CBOs – these included HIV/AIDS education and demand creation for HIV testing services, early childhood development centres, home and community based care teams, and school and community food security projects.
Ikusasa Sustainable Community Development: Over the years AFSA has supported a number of community development and economic strengthening projects that extend beyond HIV/AIDS, as it had become clearly evident that unemployment, poverty and food insecurity rendered communities in such circumstances especially vulnerable to HIV/AIDS, TB and a range of poor health outcomes. In 2014 AFSA set up a new division within AFSA known as Ikusasa (the Zulu word for Tomorrow) to manage these type of projects which included amongst others: food security, climate smart agriculture, water harvesting, financial literacy and economic strengthening (savings clubs and cooperatives); construction and maintenance projects for social infrastructure, and training of traditional leaders on environmental land use. This work has been funded and supported through the KZN Department of Social Development, the KZN Department of Agriculture and Rural Development, Irish Aid, and the British High Commission.
In 2015 AFSA was selected by the Country Coordinating Mechanism as one of eight Principal Recipients for the Global Fund Grant to South Africa for the period April 2016 to March 2019. In 2016 AFSA was contracted by the Global Fund to manage the implementation of the following components of the Grant:
Prevention programs for other vulnerable populations
- Services that support the prevention of Gender Based Violence, including combination prevention and linkage to care and support: interventions implemented in KwaZulu Natal, Mpumalanga, Limpopo and North West Provinces.
- Vulnerable Populations in hot-spots reached with HIV prevention (including HCT) by Faith Based Organisations – interventions implemented in hot spots, identified through geospatial mapping, in KwaZulu Natal.
Prevention programs for adolescents and youth, in and out of school
- HIV combination prevention package targeting vulnerable youth in Technical, Vocational, Education and Training (TVET) Colleges in KZN and Gauteng.
Community Systems Strengthening – in KwaZulu Natal, Mpumalanga and Limpopo
- Strengthen the coordination and capacity of faith-based and traditional leadership structures to implement prevention and upliftment programs within vulnerable communities.
- Strengthen the coordination of the GF HIV and TB response at a national, provincial and local level.
- Provide capacity building of 120 organisations (CSOs and other structures) in the districts and provinces where Global Fund services are being delivered.
- Promote socio-economic development, empowerment and wellness through training on business skills, risk management, life skills and health screening (BizAids package) with informal traders, owners of micro-enterprises, their clients and families in targeted districts of Mpumalanga and Limpopo.
AFSA’s appointment as a Principal Recipient for the Global Fund grant necessitated accelerated organisational change to achieve rapid scale up and meet the program deliverables.
AFSA, over the course of its history, has managed funding grants totalling R900 million and has supported and worked with 500 sub-recipients and community partners across 60 local and 6 metropolitan municipalities in South Africa.
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